In March 2012, an algorithm for the treatment
of
We compared 54 patients treated by a Medoff sliding plate (MSP) with 60 stabilised by a compression hip screw (CHS) in a prospective, randomised study of the management of intertrochanteric femoral fractures. Four months after the operation femoral shortening was determined from radiographs of both femora. In unstable fractures the mean femoral shortening was 15 mm with the MSP and 11 mm with the CHS (p = 0.03). A subgroup in which shortening was classified as large, comprising one-third of the patients in each group, had a similar extent of shortening, but more medialisation of the femoral shaft occurred in the CHS (26%) than in the MSP (12%) group (p = 0.03). Five postoperative failures of fixation occurred with the CHS and none with the MSP (p = 0.03). The marginally greater femoral shortening seen with the MSP compared with the CHS appeared to be justified by the improved control of impaction of the fracture. Biaxial dynamisation in unstable
Aims. Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN. Patients and Methods. Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an
We performed dynamic MRI of the femoral head within 48 hours of injury on 22 patients with subcapital fracture of the neck of the femur and on a control group of 20 of whom ten were healthy subjects and ten were patients with an
Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), now limited to a few specialized centres. In this study, we provide the clinical results of 400 consecutive MoM HRAs implanted more than 20 years ago in one such centre. A total of 355 patients (400 hips) were treated with Conserve Plus HRA between November 1996 and November 2000. There were 96 female (27%) and 259 male patients (73%). Their mean age was 48.2 years (SD 10.9). The University of California, Los Angeles (UCLA) hip scores and 12-item Short Form Survey (SF-12) quality of life scores were reported. Survivorship was assessed using Kaplan-Meier analyses.Aims
Methods
Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student’s Aims
Patients and Methods
The purpose of this study was to identify factors
that predict implant cut-out after cephalomedullary nailing of intertrochanteric
and subtrochanteric hip fractures, and to test the significance
of calcar referenced tip-apex distance (CalTAD) as a predictor for
cut-out. We retrospectively reviewed 170 consecutive fractures that had
undergone cephalomedullary nailing. Of these, 77 met the inclusion
criteria of a non-pathological fracture with a minimum of 80 days
radiological follow-up (mean 408 days; 81 days to 4.9 years). The
overall cut-out rate was 13% (10/77). The significant parameters in the univariate analysis were tip-apex
distance (TAD) (p <
0.001), CalTAD (p = 0.001), cervical angle
difference (p = 0.004), and lag screw placement in the anteroposterior
(AP) view (Parker’s ratio index) (p = 0.003). Non-significant parameters
were age (p = 0.325), gender (p = 1.000), fracture side (p = 0.507),
fracture type (AO classification) (p = 0.381), Singh Osteoporosis
Index (p = 0.575), lag screw placement in the lateral view (p =
0.123), and reduction quality (modified Baumgaertner’s method) (p = 0.575).
In the multivariate analysis, CalTAD was the only significant measurement
(p = 0.001). CalTAD had almost perfect inter-observer reliability
(interclass correlation coefficient (ICC) 0.901). Our data provide the first reported clinical evidence that CalTAD
is a predictor of cut-out. The finding of CalTAD as the only significant
parameter in the multivariate analysis, along with the univariate
significance of Parker’s ratio index in the AP view, suggest that
inferior placement of the lag screw is preferable to reduce the
rate of cut-out. Cite this article:
Most hip fractures treated with modern internal
fixation techniques will heal. However, failures occasionally occur and
require revision procedures. Salvage strategies employed during
revision are based on whether the fixation failure occurs in the
femoral neck, or in the intertrochanteric region. Patient age and
remaining bone stock also influence decision making. For fractures
in young patients, efforts are generally focused on preserving the
native femoral head via osteotomies and repeat internal fixation.
For failures in older patients, some kind of hip replacement is
usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers
from previous internal fixation devices all pose technical challenges
to successful reconstruction. Attention to detail is important in
order to minimise complications. In the majority of cases, good
outcomes have been reported for the various salvage strategies. Cite this article:
Transtrochanteric rotational osteotomy (TRO) is performed for
young patients with non-traumatic osteonecrosis of the femoral head
(ONFH) to preserve the hip. We aimed to investigate the long-term
outcomes and the risk factors for failure 15 years after this procedure. This study included 95 patients (111 hips) with a mean age of
40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up
was 18.2 years (3 to 26). Kaplan–Meier survivorship analyses were
performed with conversion to total hip arthroplasty (THA) and radiological
failure due to secondary collapse of the femoral head or osteoarthritic changes
as the endpoint. Multivariate analyses were performed to assess
risk factors for each outcome.Aims
Patients and Methods
The purpose of this paper is to discuss the risk
factors, prevention strategies, classification, and treatment of
intra-operative femur fractures sustained during primary and revision
total hip arthroplasty.
In the majority of patients with slipped upper
femoral epiphysis only one hip is involved at primary diagnosis. However,
the contralateral hip often becomes involved over time. There are
no reliable factors predicting a contralateral slip. Whether or
not the contralateral hip should undergo prophylactic fixation is
a matter of controversy. We present a number of essential points
that have to be considered both when choosing to fix the contralateral
hip prophylactically as well as when refraining from surgery and
instead following the patients with repeat radiographs.
This conversation represents an attempt by several
arthroplasty surgeons to critique several abstracts presented over
the last year as well as to use them as a jumping off point for trying
to figure out where they fit in into our current understanding of
multiple issues in modern hip and knee arthroplasty.
We studied prospectively the change over ten years in mortality, walking ability and place of residence after a hip fracture in 753 patients in Japan. We compared the deaths observed in these patients with those expected in the general population, matched for age, gender and calender year at the time of fracture. The survival rate decreased dramatically for two years after the event and the mortality risk remained higher for ten years. This risk was approximately double that of the general population, even at ten years after fracture. The risk was higher, and remained so for longer, in younger rather than in older patients. The proportion of patients who were able to walk outdoors alone, with or without an assistive device, was 68% (514) before fracture. This decreased to 56% (340) by one year after and remained stable at approximately 63% (125) until ten years. The proportion of patients living in their own home was 84% (629) before fracture, 81% (491) one year later, and then remained stable at approximately 86% (171) until ten years after the event.